My Doctor sent me for a MTI and it came back normal. He then sent me to a Doctor that did a EMG, which showed that I have severe, uncontrollen TN, which right now the pain is controled by meds. and I can eat again, after losing 150 lbs. I would suggest that any one with TN, have a EMG.
Is it possible to localize where the trigeminal nerve lesion is with this test? One of my concerns is that based on clinical history and response to treatment TN can be diagnosed. The problem is to know if the problem is at the brain, root, or branches. An MRI can determine if there are brain lesions, such as in MS; it can detect if there are vascular compressions. But if it doesn't show anything? a compression cannot be ruled out with a negative MRI. I asked the neurosurgeon and he doesn't know. It it's possible to detect it there could be branch lesions with this test? My TN type I on v2 and v3. My MVD did not work even though there were 3 vessels removed.
Carolina
To answer Carolina's inquiry, "no". It isn't possible to localize where the trigeminal nerve lesion is, at least not ALL lesions associated with the pattern of volleys of electric-shock pain. In roughly 20% of MVD operations, compressions are foud that were not indicated in any previous imagery.
At present, there is no single test or combination of tests or imagery that unambiguously confirms TN or ATN. Even a positive MRI showing compressions near the root of the trigeminal nerve is not "definitive" -- though it can confirm a doctor's opinion based on case history and patterns of pain. One of the things we don't hear very often is that in autopsies it is quite common to find nerve compressions of the trigeminal or other cranial nerves, in people who have never presented with neuropathic face pain. It is quite unclear what distinguishes the tiny minority of people who do develop facial neuropathic pain from those who do not, with the same types of nerve compressions. One of the challenges to research at present is the development of blood or nervous system "markers" that can confirm the presence and origins of neuropathic pain. We're a long way from having anything reliable or measurable.
Sorry to rain on your parade, Carolina..
Go in Peace and Power
Red
Thank you Red,
I know, and it is very frustrating. I am frustrated because we cannot get to the cause of the problem to solve it. The blood vessel compression is just 1 cause that has been identified and the only one that can be treated through MVD. However, everything else is speculation and we end up using trial and error in treating a symptom. This game of throwing everything at TN or TNA to see what sticks has left many of us with nerve damage, sometimes beyond the trigeminal nerve, and sometimes worse than we were before starting to "treat".
I am frustrated today...
What is an MTI?
MTI= "Magnetization Transfer Imaging". It's a specialized technique in the same class with Magnetic Resonance Angiography. Although the vocabulary is very medically dense, the following may give some idea of what is involved and why the technique is used, Elaine:
Regards, Red
Richard A. “Red” Lawhern said:
MTI= "Magnetization Transfer Imaging". It's a specialized technique in the same class with Magnetic Resonance Angiography. Although the vocabulary is very medically dense, the following may give some idea of what is involved and why the technique is used, Elaine:
http://books.google.com/books?id=jjvFj6aQeMgC&pg=PA31&lpg=P...
Regards, Red
This link wont go through. You are up light. I would like to share some of my consult with you today. Is that ok?
Richard A. “Red” Lawhern said:
MTI= "Magnetization Transfer Imaging". It's a specialized technique in the same class with Magnetic Resonance Angiography. Although the vocabulary is very medically dense, the following may give some idea of what is involved and why the technique is used, Elaine:
http://books.google.com/books?id=jjvFj6aQeMgC&pg=PA31&lpg=P...
Regards, Red
Sorry - it was a 3-line URL... and I'm going to bed shortly. Send me a note through site Email, and I'll get back to you tomorrow morning.
Ciao..R
elaine48 said:
Saving… Who would benefit from that type of test? I beleve there is one for glosso and linguil. Also my ENT said the face lift must be reversed. I kept picturing Joan Rivers. Dr. Brown felt it wasnt TN, but my spinal surgeon said there is scar tissue by the clivus. I really locked in the muscle today and I could barely walk. I am leaning to the rightin the morning. There is no relief until my tissue loses the edema. I used the humidifier at 12;30 to gain relief. There are some valuable tips in my fibro newsletter that our members can use. I will post as soon as I can. I have gained so much knowledge from this group. So do I cancel my 500.00 headache clinic appt. My interest was in the use of lidoderm injections into the cervical spine. There is a cervical gel head helmet that can be frozen or microwaved as well as a neck one. Its the cheapest on Amazon.also the rounded long support pillows offer relief as well. I will post the others asap.Are there tests for glosso or lingual nerves as well.The opinion from most is that this is not TN, but I would certainly appreciate having a neck back. Thank you so much for a wonderful group and I would like to offer my help in any way. Knowledge is the key.
elaine48 said:
Saving…
elaine48 said:
What is an MTI?Sorry Elaine, I meant to type MRI.
Elaine, to answer what I believe your question was, Elaine, here is another and more reachable link on Magnetic Transfer Imaging: http://radiographics.rsna.org/content/14/2/279.abstract.
As noted, the technique is used to enhance contrast, so just about anyone with suspected MS lesions or other discrete soft-tissue brain anomalies (including nerve compressions) might "benefit" from its application.
Abstract
Magnetization transfer, a new technique for improving image contrast in magnetic resonance (MR) imaging, is based on application of off-resonance radio-frequency pulses and observing their effects on MR images, as well as measuring the signal intensity with and without application of the pulses (ie, magnetization transfer ratio [MTR]). MTRs can be used to detect changes in the structural status of brain parenchyma that may or may not be visible with standard MR techniques. Use of MTRs may allow subcategorization of multiple sclerosis lesions into those with very low MTR (demyelinated lesions) and slightly decreased MTR (edematous lesions). In cases of wallerian degeneration, use of MTRs appears to allow reliable detection of changes undetectable with MR imaging or even light microscopy. In cases of infection with human immunodeficiency virus, MTRs seem to indicate that the macromolecular structure of white matter remains intact until relatively late in the course of disease. In cases of metastatic disease, MTRs of brain lesions indicate structural changes beyond the extent of the lesions seen on standard MR images. These findings may be due to chronic edema, myelin loss, and perhaps previous undetected tumor. In addition to being a new method of providing contrast, the magnetization transfer technique enables semi-quantitative, reproducible characterization of tissue and pathologic entities, which could substantially improve the specificity of MR imaging.For whatever this is worth, more knowledge is generally better than less. I would advise you to keep your appointment with the headache specialists.
In the strictest sense, I can understand why your doctors would suggest that what you are dealing with is not TN. It seems more accurate to call it iatrogenic /symptomatic facial neuropathy attendant to surgical scarring. Generally (and here my research background is not quite as firm), high resolution MRI such as the FIESTA procedure should also reveal compressions or scarring on cranial nerves other than the 5th (trigeminal). When concern is for effects in the cervical spine, I believe the magnet programs of MRI may be somewhat different than in full brain scan. This is something to ask your docs, Elaine...
elaine48 said:
Saving… Who would benefit from that type of test? I beleve there is one for glosso and linguil. Also my ENT said the face lift must be reversed. I kept picturing Joan Rivers. Dr. Brown felt it wasnt TN, but my spinal surgeon said there is scar tissue by the clivus.
I really locked in the muscle today and I could barely walk. I am leaning to the right in the morning. There is no relief until my tissue loses the edema. I used the humidifier at 12;30 to gain relief. There are some valuable tips in my fibro newsletter that our members can use. I will post as soon as I can.
I have gained so much knowledge from this group. So do I cancel my 500.00 headache clinic appt. My interest was in the use of lidoderm injections into the cervical spine. There is a cervical gel head helmet that can be frozen or microwaved as well as a neck one. Its the cheapest on Amazon.also the rounded long support pillows offer relief as well. I will post the others asap.Are there tests for glosso or lingual nerves as well.The opinion from most is that this is not TN, but I would certainly appreciate having a neck back. Thank you so much for a wonderful group and I would like to offer my help in any way. Knowledge is the key.
Sooo, REd. You mentioned that in autopsies that people have compression of nerves. So further research needs to be done to determine why some of us have neuropathic facial pain and others do not.
Now I KNOW this is controversial topic, but if we have emotional stress for whatever reasons, history of abuse in childhood or physical stress due to injury for example. May this not be a contributin factor??
Just as one has depression it can cause them to eat too much. Then because they eat too much and are overweight they become more depressed. A cycle..so to speak.
Same could be said for pain causing stress. Then the stress causing more pain. Then the pain making more strain.
Hence the importance of good pain control management.
Another point I just been thinking a lot about it; if a person does not need an anti-depressant but yet they have ATN. These drugs are used to help with the pain. Does the person have to have anxiety/depression as well in order to be treated with the tricylcic anti-depressants.
I've just seen many of us with ATN that seem to have to take anti-depressants for one thing or another and am wondering if there is a connection, or if I am just grasping at straws??? Peace, Min
I've heard other patients wonder some of the same things you do, Min. So far as I've ever been able to detect, I don't think any medical professional has attempted to trace a link between early childhood abuse and chronic neuropathic pain. With TN being as rare as it is, and childhood abuse being as common (estimated to occur in over a quarter of all families!), it could be very difficult to establish a cause/effect relationship.
Tri-cyclic antidepressants are known to be effective in neuropathic pain even at dose levels below those associated with relief from major depression. The mechanism involved in this seems to be the sodium channel in nerve firing chemistry. Functionality of this channel is shared between pain sensitivity and emotional affect. The tricyclics seem to work against neuropathic pain even in patients who do not have depression.
I quite agree that a much higher priority is needed on research relating to pain and its cure. One of the challenges of such research is that pain response is interactive with a deeply embedded fight-or-flee reaction system that crosses over into the neurochemistry of mentation as well as emotional affect. Thus systemic treatments for pain can have major side effects in depression as well as the clarity of thinking and ideation. This reality would seem to prompt research into more "targeted" pain relief, but so far I'm not seeing much on medication delivery mechanisms compatible with narrow targeting. Moreover, from some reading I've done in the past, it would appear that chronic pain that is sustained and not controlled will tend to build up toxic genetic mutations in blood hormones over time -- so in a sense the pain "feeds off itself".
There are over 20 different neurochemical and hormonal substances associated with chronic pain. And so far a great deal is unknown about either the nature of the association or its significance or its amenability to reversal toward pain free health. It's going to be a long journey, I'm afraid.
Go in Peace and Power
Red
Well…we are all in it together, not alone. If it turns out that it is something soooooooooooo simple. I’m gonna be really, really, really, ticked!!! Guess I am lucky in a sense, I get to kill TWO birds with one stone! (Anxiety&ATN)